Developed Nations, Healthcare, and Pharmacare with Professor Gordon Guyatt

Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.

The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.

He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.

For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.

Scott Douglas Jacobsen: Developed countries that have a national healthcare program will have a national “pharmacare” program as well. Canada does not. Why?

Professor Gordon Guyatt: Historical accident. When what we call Medicare was brought in, it was limited to hospital and physician services. The plan of the people who got started was that eventually it would be expanded.

It never got around to being expanded. So, it was a particular accident of the way Medicare came about in Canada. Whereas, in other countries, they considered all the issues together to a greater extent.

Jacobsen: With regards to the discussion happening now, I do recall an article with the finance minister, Bill Morneau, discussing building a committee and looking into the development of a national pharmacare program for Canada.

What is the status of that as far as you know?

Guyatt: The status of that is, at the moment, unfortunate. So, Eric Hoskins resigned as health minister in Ontario to go and work on this. We thought – it is hard to know – that he was quite progressive. That he would be doing this because it is very exciting to have a real national pharmacare.

However, Bill Morneau has gone up in public and said, ‘You know, it doesn’t really need to be a national pharmacare. It can be a mixed public-private system,’ closer to what Mr. Obama engineered in the United States.

If it happens that way, it will be extremely unfortunate. Whereas, people who are interested in national pharmacare got very excited about the apparent initiative. The way Morneau has talked about it, subsequently, has considerably dampened the enthusiasm and gotten people much more worried.

Jacobsen: This is of a concern, probably, for lower SES Canadians. People with part-time jobs. People with jobs that don’t pay that well. Jobs that are low-skill. As well, as you know better than I do, there is the health gap between Indigenous and non-Indigenous Canadians.

Not only in health span, but also in lifespan, 10-15 years in lifespan; this is a concern for poor Canadians and some Indigenous Canadians as well.

Guyatt: You can check this (More information here). But I was with a colleague yesterday who told me that the Indigenous have drug coverage. That is one group that has drug coverage. If you look at it, I believe that is the case. The Indigenous are spared the problem.

But the other folks, low-income individuals, particularly, if they are not in a job with drug benefits, do not have it. The job I am in has drug benefits. Those poorer people have a real problem.

Jacobsen: Do you know the number of people?

Guyatt: I have seen different statistics. I think it would be of the order of 15% or 20% who, when asked, would say, “I haven’t filled a prescription because of the financial issues.”

Jacobsen: What are some progressive steps Canadians can take, e.g. call their local representatives and so on, essentially, to move things forward that may help them have the national pharmacare program?

Guyatt: Letters to the federal MPs. The federal MPS are the people putting group signature type stuff for pharmacare. I think the politicians are more impressed at individual letters, individually written. Anyone who cares about pharmacare and who would like to write an, even brief, individual letter.

Those things make a difference.

Jacobsen: In terms of the representatives in Ontario, what ones would be most appealing to those of the population who are lower income in the population?

Guyatt: Kathleen Wynne did something quite progressive. She said, ‘We are covering all the drugs for everyone under 25.’ So, people on social assistance over 65 get coverage. Now, she has extended it to everyone under 25. Here is pharmacare for everyone under 25.

Now, it is a relatively easy population because people under 25 don’t usually need many drugs. So, it is good. It is nice. But a relatively inexpensive group to extend to. In terms of what is required to gain both the equity and the efficiency goals, it is a program that would simply give universal coverage.

The way we have for physicians in hospitals.

Jacobsen: Thank you for the opportunity and your time, Professor Guyatt.